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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1470495



Case Details

VAERS ID: 1470495 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-17
Onset:2021-07-01
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Public       Purchased by: ?
Symptoms: Echocardiogram normal, Electrocardiogram normal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin 200mg daily
Current Illness: None
Preexisting Conditions: Bicuspid Aortic Valve
Allergies: None
Diagnostic Lab Data: EKG, 2D echo performed on: 7/9/21
CDC Split Type:

Write-up: Unknown lot #. Syncope s/p 2 weeks from vaccination


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